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Your vagina is a pretty low-maintenance body part (it cleans itself, after all). But for some women, it can be a major pain—literally. Numbers vary, but a small percentage of otherwise healthy women deal with rare but very real vaginal conditions that cause excruciating discomfort that makes having sex—and even day-to-day activities like sitting down—extremely difficult. And the worst part is, doctors don’t always know what causes them, which means treatment can be spotty or nonexistent. Here are five down-there disorders that make life difficult for some unlucky ladies.

This is typically what happens when you have vaginismus, a mysterious disorder characterized by involuntary tightening of the pelvic floor muscles that control the vagina, says Teresa Hoffman, M.D., an ob-gyn at Mercy Medical Center in Baltimore. The clenched muscles can be uncomfortable or painful, even triggering spasms. “What causes it isn’t clear, but there may be a psychological component to it, such as anxiety or past sexual abuse,” says Hoffman. The good news is, vaginismus can be treated. One option involves Kegel exercises: tightening and then releasing the pelvic floor muscles over time to help you gain control over them. Another treatment option is to insert slender plastic dilators you get from your doctor into the vagina regularly to relax the pelvic floor muscles.

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Women with vulvodynia experience chronic pain at the opening of the vagina. We’re not just talking about a dull ache; the pain is often described as being an intense burning sensation, says Hoffman. The worst part is, it’s unclear what’s behind it. “Glands at the opening of the vagina become inflamed for some reason, making it too painful to have sex,” says Hoffman. Even activities like walking or sitting can be excruciating. Since the cause is unknown (it’s not related to STDs or other infections), treatment generally involves lessening the symptoms. That can mean going on antidepressants or other meds or having surgery to excise the inflamed areas, says Hoffman.

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Add lichen sclerosus to the long list of side effects of perimenopause, that life stage in your mid- to late-40s when production of sex hormones such as estrogen begins to wind down. “Lower estrogen levels can result in the formation of thick white plaques on the skin of and around the vagina,” says Hoffman. “It’s very itchy; it’s like eczema of the vagina.” Besides the pigment change, vaginal tissue affected by lichen sclerosus becomes thinner, which can also lead to discomfort and irritation. In severe cases, it can even make sex impossible. Luckily, lichen sclerosus can be treated with steroids or topical estrogen, says Hoffman, but it needs to be seen by your gyno so she can properly diagnose it.

The hymen—the ring of tissue at the entrance to the vagina—normally has a small hole in it, to allow menstrual blood and other fluid to escape. But some girls are born with an imperforate hymen, meaning this membrane totally blocks off the opening of the vagina, says Hoffman. “It’s usually diagnosed in teenagers after menstruation begins: The blood from a girl’s first periods has no way of leaving her vagina, so it builds up inside, causing a lot of pain,” says Hoffman. Once diagnosed, the hymen is corrected via a relatively minor surgical procedure, and it won’t affect a girl’s ability to have sex or get pregnant in the future.

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Feeling an egg-size lump on your labia would be pretty freaky, right? That’s what can happen if you develop a cyst in the Bartholin’s gland in your vagina. Here’s the lowdown: Each side of your outer labia contains a Bartholin’s gland, a tiny organ that exists to lubricate the outer end of the vagina. Thing is, it’s not uncommon for one of the Bartholin’s gland ducts to become clogged. Fluid builds up inside the duct, triggering a lump that can range in size from a pea to a marble, says Hoffman. Crazy as that sounds, the real problem happens when the duct becomes infected, turning into an absess. You’ll know this is the case because the lump will feel tender and painful, and you may even develop chills and a fever. “If that duct forms a cyst, it might be uncomfortable but not painful,” says gynecologist Laurie Streicher, M.D., the author of Sex Rx: Hormones, Health, and Your Best Sex Ever. “An absess, on the other hand, is horribly painful. Patients come in [to the doctor’s office]  waddling like a duck, saying, ‘You’ve got to see me right now.’” 

Should this happen to you, you need to hit your gyno’s office to have it drained, or the abscess will just get worse.  “Antibiotics are needed too, to keep the infection from coming back,” says Hoffman. Cysts and absesses can recur in women who’ve had them before. “Unless you remove the gland, it can come back,” says Streicher, who explains that that’s really only an option for women who keep having absesses form (you won’t notice anything different once you heal from surgery, but it is a painful procedure). And although there are no preventative measures you can take to prevent cysts, Streicher says that for the majority of women she’s treated for an absess, she’s drained it once and not seen recurring issues afterward.